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Headaches Quiz

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Which description best characterises a typical tension-type headache?

A Progressively worsening morning headache associated with vomiting and papilloedema
B Severe periorbital pain with ipsilateral lacrimation and nasal congestion
C Bilateral, band-like, non-pulsatile pain of mild to moderate intensity ✓
D Sudden onset occipital pain reaching maximum intensity within minutes
E Unilateral throbbing pain associated with photophobia and vomiting

The answer is C: Bilateral, band-like, non-pulsatile pain of mild to moderate intensity

Explanation

Why C is correct

See Tension Headache. Option C is correct because tension-type headache is typically bilateral, with a pressing or tightening quality, non-pulsating, and of mild to moderate intensity. People often describe a tight band or a squeezing feeling around the head. It is the most common primary headache (a headache that is not caused by another disease). Unlike migraine, it is not made worse by routine physical activity such as walking or climbing stairs, and it does not usually come with nausea or marked light sensitivity. It is linked to stress and fatigue, and the neurological examination is normal. NICE CKS lists these same features: bilateral location, pressing or tightening quality, non-pulsating, mild or moderate intensity, and not aggravated by routine physical activity. Management includes reassurance and advice on avoiding overuse of painkillers, because that can lead to medication-overuse headache. A memory aid: tension-type headache is like a tight hat, on both sides, squeezing and not throbbing.

Site: bilateral.
Quality: pressing or tightening and non-pulsating.
Severity: mild to moderate.
Activity: not made worse by routine physical activity.

Why the other options are incorrect

A. Progressively worsening morning headache associated with vomiting and papilloedema: A progressively worsening morning headache with vomiting and papilloedema (swelling of the optic disc seen on eye examination) suggests raised intracranial pressure, for example from a tumour. This is a secondary headache. It would be the answer if the question asked about a red flag.
B. Severe periorbital pain with ipsilateral lacrimation and nasal congestion: Severe periorbital pain with same-sided tearing and nasal congestion describes cluster headache. Tension-type headache is mild to moderate, with no autonomic features. It would be the answer for a severe one-sided attack around the eye.
D. Sudden onset occipital pain reaching maximum intensity within minutes: Sudden occipital pain peaking within minutes suggests a thunderclap headache from a subarachnoid haemorrhage. It is a red flag, not a primary headache. It would be the answer for an emergency presentation.
E. Unilateral throbbing pain associated with photophobia and vomiting: Unilateral throbbing pain with photophobia and vomiting describes migraine. Tension-type headache is bilateral and non-pulsating. It would be the answer if the pain were one-sided and pulsating.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
A 22-year-old woman reports recurrent headaches since her late teens. They are unilateral, throbbing, associated with nausea, and she prefers to lie in a dark, quiet room. Before some attacks she notices flashing lights in her vision. Which single feature best supports a diagnosis of migraine rather than tension-type headache?
2
In a person with a pre-existing headache disorder, which pattern meets the frequency and duration criteria for medication-overuse headache related to paracetamol or ibuprofen?

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